The design of hospital and other healthcare facilities both reflects and shapes how health care is delivered.

George J. MannRosalyn CamaAs the original construction costs of large, curative-focused facilities are increasingly dwarfed by ongoing operating costs, and as the industry continues its shift to value-based care, the design of healthcare facilities must recognize and respond to present necessities while anticipating future trends.

“Facilities design must reorient its thinking from an approach that is strictly curative to one that is preventive,” says George J. Mann, AIA, professor of architecture and the Ronald L. Skaggs, FAIA Endowed Professor of Health Facilities Design, College of Architecture, Texas A&M University, and founder of the RPD Group. “It needs to reflect what brings people into the hospital in the first place and address those needs, enhancing preventive care which may lessen the need for acute care for many chronic conditions.”

Where We Are

The need for improved access to care, challenges with healthcare affordability, and a recognition of the importance of patient experience continue to drive the industry’s shift to value. Meanwhile, acute care hospitals fed by emergency department admissions are straining under that shift coupled with increasing pressures caused by homelessness, addiction, and an aging population. Local and outpatient pathways for care in the form of operating and treatment rooms, laboratories, and ambulatory care facilities in medical office buildings, strip mall shopping centers, and big box stores offer emergency services that previously could be accessed only in a large hospital. Moreover, with fewer inpatient beds, these new care venues enable providers to offer access to high-quality health care at a substantially lower cost than can be delivered in a more traditional hospital. Hospitals still require beds, but excellent preventive care is a means to help avoid expensive inpatient care.

In addition to helping to reduce hospital admission rates, the new facilities reflect a growing awareness of the need for patient-centered atmospheres, furnishings, food service, and other hospitality-related needs.

Where We’re Going

Comprehensive community-based, primary healthcare programs are emerging as the gateway for patients to enter the health system and as the first line of defense in preventing illness.

“Larger facilities have to take a proactive attitude and reach out through the network of these smaller facilities to reach the community. The nature of that varies according to the geography, population density, and demographic facts of the area,” Mann says.

Smaller facilities, with direct connections to larger health systems, offer multiple ways for health systems to respond to needs and can reduce healthcare costs through local and outpatient care that helps keep people out of the hospital. These will continue to expand to serve the needs of their communities by offering early diagnosis of disease, as well as tests, treatments, and interventions that keep patients close to home and that offer home care for treatment and follow-up rehabilitation.

Both Mann and Rosalyn Cama, president and principal interior designer of CAMA, a health design studio and lab in New Haven, Conn., agree that facility designs must address the root causes of disease, the costs incurred to treat disease, and the need for patient education and prevention outreach. “The question is how to bring designers into the discussion of outcomes and solutions from the beginning,” Cama explains.

“The mission and mindset of a comprehensive healthcare network and the major hospitals within that network need to be first to prevent disease and, then, if disease occurs, to treat it efficiently, effectively, and swiftly,” Mann says.

Rather than viewing facilities design as a strictly architectural discipline, healthcare leaders should recognize its potential for being an interdisciplinary, collaborative process among architects, physicians, public health professionals, demographers, and statisticians.

Design strategies that leverage technology also are playing an increasing role in streamlining workflows, improving efficiencies, and measuring data. Such efforts in combination are required to develop and undertake innovative, local responses to prevention, existing health problems, and the causes of illness and death.

“Healthcare needs to address a fundamental lack of understanding between public health and health architecture, including those societal ills that strain health care, such as homelessness, addiction, and an aging population,” Mann says.

Efficiently, sustainably designed healing environments also include features that can contribute directly to reduced operating costs, such as:
  • Sensors to turn lighting on and off
  • More efficient uses of fuel
  • Sustainable construction materials
  • The source of materials, how they are used, and how they are delivered to the construction site
  • Sun orientation, the color of the building, and fenestration
  • Healing gardens
  • Natural light

Increased well being, through a humane aesthetic and injury prevention, as well as room design, the design and implementation of furnishings, and product design and delivery for both onsite and offsite care also contribute to overall cost reductions. For example, Cama notes, dangerous falls in hospital rooms usually occur when there is a turn in a patient’s route from bed to toilet. “Such knowledge changes the question from how to prevent falls to how to design a room without those turns,” she explains.

The outcomes-based design of furniture and furnishings also can support healing. For instance, evidence has shown family contact and touch (e.g., a three-position bed chair from which family can easily reach bed-ridden patients to provide the human touch) play a role in healing and promoting a reduced length of stay.

“We’re not looking at facilities or product design for their own sake but for the outcomes we’re trying to achieve and the problems that need to be solved,” Cama explains.

The future of health care will have less emphasis on acute inpatient care health facilities and more on prevention and humanized architecture, with single-bed rooms for inpatient-focused care. Facility design will focus on enabling adaptive reuse and conversion for purposes such as the following:
  • Community-based health programs, with an emphasis on prevention and primary care, that can serve as a “gateway” into a health system
  • Centers of excellence designed to offer disease-based, multidisciplinary, comprehensive continuums of care
  • Ambulatory surgical centers that provide same-day, outpatient surgical care, including diagnostic and preventive procedures not requiring inpatient care

Publication Date: Wednesday, March 08, 2017